Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality
Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. What is the effect of an invitation to a single prostate-specific antigen (PSA) screening on prostate cancer detection and median 10-year prostate cancer mortality?
This interesting study evaluates the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer-specific mortality.
The screening was simply an invitation to attend a PSA testing clinic and receive a single PSA test. It was compared to standard (unscreened) practice (opportunisting screening or only selected subjects motivated and informed about screening cancer, according to the EAU and AUA guidelines).
In this randomized clinical trial comparing men aged 50 to 69 years undergoing a single PSA screening (n = 189 386) vs controls not undergoing a PSA screening (n = 219 439), the proportion of men diagnosed with prostate cancer was higher in the intervention group (4.3%) than in the control group (3.6%); however, there was no significant difference in prostate cancer mortality (0.30 per 1000 person-years for the intervention group vs 0.31 for the control group) after a median follow-up of 10 years.
The single PSA screening intervention detected more low-risk prostate cancer cases but had no significant effect on prostate cancer mortality after a median follow-up of 10 years. Although longer-term follow-up is under way, the findings do not support single PSA testing for population-based screening.
Richard M. Martin, PhD, Jenny L. Donovan, PhD, Emma L. Turner, PhD, Chris Metcalfe, PhD, Grace J. Young, MSc, Eleanor I. Walsh, MSc, J. Athene Lane, PhD, Sian Noble, PhD, Steven E. Oliver, PhD, Simon Evans, MD, Jonathan A. C. Sterne, PhD, Peter Holding, MSc, Yoav Ben-Shlomo, PhD, Peter Brindle, MD, Naomi J. Williams, PhD, Elizabeth M. Hill, MSc, Siaw Yein Ng, PhD, Jessica Toole, MSc, Marta K. Tazewell, MSc, Laura J. Hughes, BA, Charlotte F. Davies, PhD, Joanna C. Thorn, PhD, Elizabeth Down, MSc, George Davey Smith, DSc, David E. Neal, MD, and Freddie C. Hamdy, MD7, for the CAP Trial Group. Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality. JAMA. 2018 Mar 6; 319(9): 883-895. 10.1001/jama.2018.0154